CIIS Public Programs Podcast

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This is the CIIS Public Programs Podcast, featuring talks and conversations recorded live by the Public Programs department of California Institute of Integral Studies, a non-profit university located in San Francisco on unceded Ramaytush Ohlone Land. 
 
For years, Mark Epstein kept his beliefs as a Buddhist separate from his work as a psychiatrist. But as he became more forthcoming with his patients about his spiritual learning, he was surprised to find many were eager to hear more. The divisions between the psychological, emotional, and the spiritual were not as distinct as one might think. In this episode, Dr. Epstein is joined by CIIS professor and psychologist Alzak Amlani in a conversation about his life, his work, and his latest book, The Zen of Therapy. 
 
This episode was recorded during a live online event on January 26th, 2022. A transcript is available at ciispod.com. To find out more about CIIS and public programs like this one, visit our website ciis.edu and connect with us on social media @ciispubprograms. 

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Alzak Amlani: Hello Mark. It's great to see you.  

Mark Epstein: Hello Alzak. 

Alzak: And it's really a delight to have you here at CIIS, especially after your accomplishment of your most recent book. I've read, and actually included some of your other books, Going on Being and Thoughts Without a Thinker in some of my classes, so I'm excited that I've got another piece to work with now. I 

n your book, Zen of Therapy, you state that your intention is to show that meditation does not have to be a solitary, intrapsychic endeavor. We can also work interpersonally and to demonstrate that, emotional life, rather than being a distraction, can serve as a critical doorway to spiritual understanding. And I was quite intrigued about that integration that you brought. There's such a complexity and richness in how you take us into the room with your patients and how you weave your psychotherapeutic work, primarily from Western psychoanalytic approaches as well as your Buddhist meditation and study over the last 30 years. You sprinkle various chapters with Japanese haiku. And you also quote, from the musician, John Cage, in a few chapters, and I especially enjoyed reading about your psychological understanding of the life of the Buddha. Maybe you could start with this larger context and how these various streams have come together for you, especially in writing this book. 

Mark: I’d be happy to. I'm not sure that everyone who's listening knows my background or anything. So that, I think it might be helpful. Just to start with a little bit of that material. The kind of strange thing and the unique thing about my experience is that although I am a traditionally trained psychiatrist, which means I went to medical school, you know, etcetera. I was immersed in Buddhist thought and Buddhist practice from a very young age. Way before I decided to become a psychiatrist. So I was, you know, fortunate enough to be exposed to Vipassana meditation, mindfulness meditation, teachers like Joseph Goldstein, Jack Kornfield, Sharon Salzberg, Ram Dass starting in my early, early twenties, and traveled in Asia with all of them to meet their spiritual teachers and so on.  

And then went from that experience, doing a lot of silent retreats, as many as I could manage to integrate into my life at the time. I went from all of that to medical school and then to training as a psychiatrist. So, all of that training, which I had under the umbrella of a lot of very good traditional psychoanalytic psychotherapists, I looked at that training always through a Buddhist lens because the Buddhist psychology was already- that was the first thing that I found that made any sense to me.  

So all of my writing and a lot of my clinical work in the next, you know, 40 years or whatever it has turned out to be, has been about first in my mind, trying to translate or interpret Buddhist psychology into the Western, psychodynamic language that we all speak, even if we're not Freudian, you know, that those ideas of 100 years of psychoanalysis have kind of permeated the way we think about our minds and our personalities, our character, and so on. So, I wanted to make Buddhist psychology Buddhist meditation, I wanted to explain it in a way that Western people could understand. That was my internal mission in a lot of my early books.  

But the question that kept coming to me that I evaded as much as I could for many years was well, okay. Okay, but how do you actually bring your Buddhist understanding, your meditation background, how do you bring that into the practice of psychotherapy? Do you teach your patients to meditate? Do you sit silently with them? Do you give them instruction? And I was always, no. No, I'm just- when I'm a therapist, I'm just being a therapist. But and hopefully, if the Buddhist, if the Buddhist thing has made an impression on me, it should be coming through me in some way. So, I was content to let it be a kind of implicit or silent influence. If patients would come to me, who are interested in Buddhism or wanted to learn about meditation, I would certainly give them guidance, tell them where to go to learn. But I didn't actively try to proselytize or convert or even teach meditation in the psychotherapy office. I was content to just be the therapist.  

But with this book, which I began probably three or four years ago when I was already in my early to mid 60's, I decided, okay. It's been enough time. I should be able to start to answer that question. How am I really bringing my Buddhist self, if we can use that word, how am I really bringing my Buddhist self to this practice in psychotherapy? And I decided to set myself an agenda to try to find out, or to try to describe, to try to put words on something that I had avoided putting words on because I wanted it to come, as I said, more organically.  

So, I decided towards the end of 2018 to write down at least one psychotherapy session a week in which I felt that something of my spiritual understanding or background or attempt to, you know, channel that- that something of my spiritual understanding was infiltrating the psychotherapy session and I decided I would try to do that at least one session a week. So, I would take notes immediately after the session, which I don't ordinarily do, unless I'm giving medication or something, you know, extremely important has happened. But I tried as much as possible to write the session down and then in my writing time, usually over the weekend or the following Monday, I tried to write the session up, describing it as close to the bone as I could, but in a, you know, in a kind of literary fashion. And I did that for a year, forcing myself to pick these sessions out and not following any given patient, but allowing, because I'm seeing 30 or 40 people a week, allowing one session to, you know, that this is the one that speaks to me. So, at the end of the year, I had a kind of mosaic or a collage or a kaleidoscopic version of, you know, one year's worth of therapy in my office, and, and then I started to read through the sessions, which I hadn't done for the entire year, to see what I might discover from what I had recorded, you know.  

And that was the beginning of this book, that then I can go on talking. I hope you- hopefully, you have other questions that, that I'll give you time for, [Alzak: Absolutely.] but after- after going through the year’s worth of sessions, I took that stack of material and showed it to the editor that I have at Penguin, who did my last two books, to ask her if she thought there was something of interest here and she read through it and she said yeah, I think there's something here, people would be interested in this, you know, a therapist kind of showing what goes on like in treatment or something, but she said there's no real- the only real through line is you because you're not following any individual cases. So, she suggested that I go through and write like a reflection or a commentary on each session, showing more about what was going through my mind. What I was seeing, what I was thinking in each session, so I always listen to her because she only gives me very tiny bits of advice, which are usually correct. And then Covid hit.  

So, it so happened that this year of recording these psychotherapy sessions turned out to be the last year before Covid. So, everything went remote. I had a record of the last year of face-to-face in office psychotherapy, you know, and then I was in quarantine, you know, with this project. So, it was a very good time. It was like being on retreat, like a writing retreat. And I really spent time with going through the sessions and thinking about what might have happened, and what I was seeing and meanwhile, the seasons were passing, it was like, you know, winter and then spring. And I'm really noticing all like- I'm in the country and you know, the clouds and the flowers and the summer and fall, so each session started to look like a Japanese haiku, you know, because in the tiny details of the session, I started to see, oh there's so much happening. So, I- so that's where the Zen of Therapy, which is the title of the book, that's where that started to come in.  

So, that theme of looking at the tiny details and seeing, you know, the whole world, I started to tap that. And then, I let myself bring in all the other important influences that have been with me for many years now. So, including the composer, John Cage, the British pediatrician and psychoanalyst, Donald Winnicott, Ram Dass, the Dalai Lama, Joseph Goldstein, and Jack Kornfield. There's a British writer, Adam Phillips, who's influenced me a lot. So all- the book became a kind of woven tapestry of all of these influences on my way of thinking and working and that's probably enough as a first answer, we could talk about it more.  

Alzak: That's beautiful. I love how it took several iterations and you didn't know exactly where it was going to lead. And how it sounds like the writing of it, and then collaborating with your editor and then the ambience of the seasons, it all sort of fed into the creation of the book and that really comes through in the way you’ve written it.  

Mark: Yeah, I really didn't know, excuse me, that it would be a book at first, and it was only in writing those reflections that I started to get a sense of, oh, this really could be a book and it really was interesting for me. Like, how am I bringing a Buddhist sensibility to what I'm doing? I started to pick out some of the important themes in- for me in what that might mean. And then of course, I had to show everything that I was writing to the patients who I was writing about. So, my description of the sessions and then my commentary on the sessions and we would have a back and forth about what pseudonym did they want to use? And was it- could I change, how can I change the identifying characteristics? But- but we wanted to make the sessions as accurate as possible and, and they learned more from that process because I had to tell them more about what I was actually thinking than I would do ordinarily in a regular session. And so those sessions that would have probably disappeared into the recesses of the past became, in a kind of anti-Buddhist way, because they were preserved, you know, but they became, they became touchstones in a way for these various psychotherapies that we were engaged in together. 

Alzak: Wow, fascinating. So multiple levels of work going on here.  

Mark: So many levels. 

Alzak: Which is, so yeah, so rare and so unusual, so I'm trusting it was quite an enriching process for you to engage all these levels with the folks, the patients that you worked with. One of the things that really struck me is you said, how I'm curious, one of the things that you spoke about is how are interpersonal encounters meditative? You know, and so, you're speaking about the relationship, the work you're doing with patients for the session, during the session as meditative encounters. Can you speak more about- as interpersonal encounters, excuse me. Can you speak more about how they’re meditative? 

Mark: Sure, well we're used to thinking of meditation as something that we do in a solitary way. You know, that it's a one-person event. Intrapsychic, like we're looking inside ourselves and cultivating a certain kind of posture, mental posture or mental stance, but why should meditation have to be so internal? That's where the John Cage influence started to come in for me. John Cage, I don't know, I don't know how familiar you are with him. But he studied Buddhism in 1951 with a visiting Japanese Buddhist scholar, D.T. Suzuki, who taught for two years at Columbia and all the sort of downtown Bohemian Intelligentsia: Erich Fromm, Karen Horney, Allen Ginsberg, Thomas Merton, Agnes Martin, Philip Guston, and John Cage, among others went to these Buddhist lectures and Cage was- Cage understood it, got it, but said, I've already decided to devote my life to music. So, any kind of sitting meditation is just going to get in the way of my music. So, I'm going to bring what I've learned about meditation to my work as a composer, in my work as a musician. And so, the first move that he made was to stop discriminating between musical sounds and non-musical sounds. So not- and in mindfulness meditation, we say don't push away the unpleasant. Don't cling to the pleasant or if there's something a little perverse about you, don't push away the pleasant and don't cling to the unpleasant, you know, but try to give impartial attention to everything there is to observe.  

Now Freud, when he taught physicians practicing psychoanalysis said exactly the same thing. He said, you know, suspend judgment and give impartial attention to everything there is to observe. If you read those words and didn't know it was Freud, you would think it was D.T. Suzuki, or you would think it was John Cage. So, there's a linking thing, you know, right there. So, and what is the point of meditation or of mindfulness? Is it to be able to be in the present moment with your breath? Is that the ultimate point? Or is the point to be able to be present with your partner, with your children, with your, you know, in your work environment? In the garden? With the outside world? So already we know from the practice of meditation that it’s not meant to be only internal. And in fact, what is, is there a distinction? Thich Nhat Hanh would always say, you know, breathe in, breathe out, but eventually you find, there's no distinction between inner and outer.  

So, why not bring that attentional posture, that attentional attitude, that we learned from meditation? Why not bring that to the practice of psychotherapy? And in fact, you know, I'm a psychiatrist, as I mentioned, which means I went to medical school, which means that when it comes time to actually training as a psychiatrist, they don't really give you any teaching, you know, it's like when it's when it's time to do dermatology, you go in and work with the dermatologist, when it's time to do surgery, you go in and assist the surgeon. When it's time to do psychiatry, you get a patient, and you go in a room with them. And so, when that, when that happened to me, what I had to draw on, was my own experience watching my own mind and my own experience in psychotherapy myself as a patient. But I decided right away, what if I try to give the same kind of non-judgmental, impartial attention that I've practiced on myself? What if I try to apply that to this patient? This first patient of mine? And that seemed to work, you know, so I think that kind of attention is fundamental to establishing a therapeutic alliance with, with the patient. And that's, you know, I talked about that a lot in the book, and I can talk about that as much as you want. But, but that's the that's the beginning of seeing psychotherapy as an interpersonal, as a two-person meditation.  

And I think there's some way, you know, in Buddhism, we talk about transmission. Like what is, what does it mean to get transmission? Or give transmission, but I think there's some way that a therapist’s attentional sensibility is felt by the patient, you know. And that if the therapist is too intrusive or too withholding, that a- the patient's defenses are, are aroused in order to guard against the threat, either of, you know, interference or abandonment. But if a therapist can be present in this way that both Freud and Buddha emphasized, then a patient becomes freer, safer. We're creating a safer environment for people to talk about what's really happening in their own experience, you know, rather than putting a facade on, even for a therapist.  

Alzak: Yeah, so that's, that's beautiful. I could see how that's, that is clearly a meditative experience because that's when we're sitting, we’re also trying to create some sort of a holding experience or a presence that can allow our own consciousness, our own thoughts, feelings, experiences to arise and be witnessed in that way. And in psychotherapy- 

Mark: Just giving your full attention to another person, you know, a therapist is uniquely positioned to give their full attention to the client, to the patient, to the person. [Alzak: Yes.] And it's an unusual experience for, you know, for the other.  

Alzak: Absolutely. Yeah. So, you also talk about looking further and feeling into our emotional lives and by doing that, we gain spiritual understanding. And I so appreciated that because you're again linking our own psychological material, our reactivity, our emotions, you know, that they need to be held. They need to be seen, they need to be witnessed in the way you're talking about by a therapist or by another, and that actually leads to spiritual understanding. So, can you speak more about that as well? And how does that do that? How does that work for you?  

Mark: Well, I think there's a tendency in spiritual circles, but not only in spiritual circles, I think it's a tendency, it's a widespread tendency to try to either rise above or bypass or suppress difficult, emotional experience. You know, why? Because it's difficult. It's unpleasant, you know, and it would be easier if we didn't have to feel it, you know.  

So, even the Buddha, and the- in the Buddha’s time, when he taught his fundamental psychology, you know, in the form of the Four Noble Truths, his first truth, he just used a single word and it was dukkha, you know. Dukkha is ordinarily translated as suffering, which is not the best translation. What the, the word connotes more like a sense of pervasive unsatisfactoriness in life. Even when things, when there's pleasant things going on, you know in the back of your mind that it's not going to last, you know, but um, but the word if you take the word apart, the word dukkha - kha means face. And duk means like difficult. So, the Buddha’s saying there's, there's something difficult to face in life. You know, there's an opposite word, sukha, which is sweet, sweet to face. So that the happiness, the joy. But dukkha, there's, there's an element, there's a dimension to life that's hard to face. We want to turn away, you know. So that's been going on since the Buddha's time, you know, and so what's the Buddha saying? He's saying that just perpetuates suffering, the turning away. What we, what we have to do, what we have to learn if we're going to follow the Four Noble Truths, what we have to learn how to do is to face that, which is difficult.  

So, from a psychotherapist’s point of view, what is it that's difficult, you know? Usually, usually there's something difficult that’s bringing someone into therapy, but they're not always so tapped into what it really is. They might be blaming this person or that person or themselves, rather than actually dealing with what is their emotional experience that they're having trouble with.  

So, I liked to look back at what's written about the Buddha's life for inspiration and what I found is that, and I knew this, but no one had ever really done anything with this that I had seen, you know, the Buddha's mother died when, when the Buddha was a week old. He was like, born from her side. He must have, must have been a Cesarean section or something. Anyway, she lived for a week and then she dies, and the Buddha, you know, when he gets to be 29 years old, he replicates his mother's abandonment of him by leaving his wife and newborn child and going off to the forest to seek his enlightenment. And for, for years, the path the Buddha takes is the one that you're asking about, where he tries to suppress, to step on, to or to rise above, to eliminate all the toxic feelings, all the difficult feelings, you know, his rage, his sense of abandonment, I would say, his sense of personal emptiness, what, whatever it might have been, he became a master of austerities, like a modern-day patient who suffers from anorexia, you know, stopped eating, became totally emaciated, drinking his own urine, until he's one day, he's falling over on himself because he's lost all of his bodily strength and then he has a childhood memory. The only time in the story of the Buddha's life where a childhood memory comes into play and he remembers a joyful feeling of when he was a boy sitting under a rose apple tree, it said, watching his father plowing in the fields. So, I take that as like a Winnicottian idea of like that, a child who knows his father or mother is in the distance, but is left alone enough to, to go off into his or her own imagination, you know, so he's sitting under the tree. He's blissing out, he has a joyful feeling, and he remembers that feeling. And he has enough presence of mind, it's like a first kind of self-analysis, you know? He has enough presence of mind to say to himself, why am I remembering this at this moment? This joyful feeling, you know, when I'm at the height of my ascetic practices and he thinks, maybe I'm trying to tell myself something, you know, maybe the way I'm going about this, trying to look away from everything that's difficult, maybe it's the wrong path. And maybe this joyful feeling is actually the key to the enlightenment that I'm seeking and then he says, but with a body so emaciated there's no way I would have the strength to sustain any kind of joy in this body.  

And at that moment, a young woman named Sujata comes into his presence and I start my book with this story because she comes bearing a bowl of rice porridge, you know, like of milk rice because she thought her nurse maid told her that there was a spirit under this tree that she had gone to, wanted to get pregnant and she had left an offering for this tree spirit and then had conceived and then her assistant told her I saw the spirit, you know, he's there. So, she comes with milk rice for the spirit, but it's the Buddha, and he takes the nourishment. And she like embodies the mother that he had lost, or the spiritual friend that he needed, you know, and he proceeds from there to go to his seat of enlightenment, you know, he walks for a couple of days and sits under the tree and then has all these experiences. But it's because he turned himself around. And that memory is said to be the beginning of the Buddha's Middle Path, which is, you know, not the indulgence of sense desire, but not the, not the reaching into the ascetic practices.  

So, I think there's something there about permitting emotional experience, the entire range of emotional experience. I think the Buddha was trying to work out something that many of us in our psychotherapies are also trying to work out which is, you know, earlier difficulties, losses, feelings of estrangement, dissociation and so on, and he found his way through that by turning himself around at that moment, and allowing the entire range of his emotional experience to enrich his mind. 

Alzak: Wow, I don't think I've ever heard that synthesis put together of his own trauma and asceticism and spiritual bypass and then the movement towards his healing in the Middle Path. That's really, that's profound and so instructive, I think for so many of us on the spiritual path, or the psychological path.  

And related to that, you have a couple of cases in your practice, at least, where you're talking about the inner critic, the super-ego, anger turned inward. This process of where we move towards self-loathing and self-rejection and how painful that is and how you work with your patients around those themes and that accessing our anger or aggression and appropriately expressing and integrating is actually a pathway towards compassion, you know, which is a really significant linking that you're doing there. And related to that, I'm curious about, you know, I think that for many listeners, you know, who might be, you know, Buddhist practitioners, who want to focus on compassion and equanimity, you know, and anger and aggression is to be eschewed. Or nice, empathic therapists who don't want to also be angry or you know, hold their aggression. So, if you could talk a little bit more about this process, this relationship between anger and kindness and compassion. I think that would be really powerful. 

Mark: Sure. Well, the way I structured the book was both according to the seasons, as I was mentioning to you earlier, winter, spring, summer, fall, but then for each of the four parts, each of the four seasons, I also wanted to have an element or an aspect of the traditional Buddhist path of insight. So, the first section became Clinging because that's what usually brings us into practice or into therapy, some kind of clinging. The second section was Mindfulness. The third section was Insight and the fourth section was going to be Compassion, you know, because that's sort of the ladder, or the trajectory or the path, but all the, all the psychotherapy sessions in the fourth section, which was supposed to be Compassion, when I read through them, they were all about anger or aggression, you know, and they were all about that because in order to, in order to reach not sentimental compassion or sort of false compassion, but in order to reach real compassion, I think, but this is not my original thought, I can tell you where, whose ideas I'm drawing on with this. But in order for compassion truly to develop in a child, in a or in an adult, one has to reckon with one's own rage, with one's own anger, with one's own hatred.  

So, often over the years when I've been teaching, sometimes with Sharon Salzberg, sometimes with Robert Thurman, sometimes the three of us, teaching to mostly Buddhist audiences, there's a famous paper that Donald Winnicott, the child psychiatrist and psychoanalyst who I mentioned earlier, who is one of the grandfather figures that I'm channeling in my book. Winnicott wrote a famous paper called “Hate and the Countertransference” in which he talks about, like he outlines, like the 15 reasons why a mother hates her infant and, and he's got a great sense of humor, Winnicott, so. So, each, each reason is, you know, like he fusses all day and then she takes him out in the stroller and a neighbor says, isn't he sweet? Or, you know, he won't take the mother's food, but then, but then takes the bottle from the nanny kind of thing. So, so Winnicott, I mean, he's amazing on this theme and all my books, I've drawn on Winnicott. And this one, I tried to keep Winnicott out of it until I got to the fourth section, which was to be about compassion, and then I just needed so much of Winnicott.  

So, I like reading that paper to the Buddhist audiences because it makes them a little nervous because as you're saying, there's a big tendency in spiritual circles to downplay one's own inner violence, you know and to pretend that it's not there. So, I like to bring it out, therapist that I am so that people can reckon with it. Winnicott's point is that there's no way in any kind of intimate relationship where people need so much from each other, that the entire range of emotions aren’t brought out. That a therapist inevitably feels anger at demanding patients. That patients inevitably feel anger at withholding, or appearing to be withholding, therapists. That babies have not yet differentiated their anger from their need, their anger from their hunger, their rage from their desire. Babies are like one bundle of emotion, and they attack the parent with what Winnicott, his favorite word was ruthless. So, with a kind of ruthless desire babies go at their parents. And so Winnicott’s first point in this paper, is that the good enough parent and he coined that phrase, the good enough mother, the good enough parent. The good enough parent doesn't reject or abandon or interfere, you know, doesn't get anxious, doesn't get withdrawn in the face of the baby’s aggression. That the good enough parent is able to, you know, kind of jostle, tease, hold, you know, reassure, like, I know you're upset, but what is it you need? we just have to change you, maybe are you hungry? You know, it's okay. The good enough parent, the devoted parent, in Winnicott's view, is able to create a good enough holding environment that the baby doesn't get the feeling that their anger is so destructive, so overpowering that they will destroy the very person who they need the most. So, anger gradually gets integrated into the whole range of human experience rather than becoming the great destructive emotion that we all fear that it is.  

Winnicott says something similar is going on in the therapeutic couple, something similar is going on in our intimate relationships, and that the- in the childhood version, when the growing child starts to realize that the mother and father are going to sometimes disappoint him or her that actually they're not under the baby's omnipotent control, you know. That they're going to let down or disappointed sometimes, but that the parents will come through, the baby starts to get the sense of the parent as having their own self, their own separate self, not being under their total control. And that that is the seed of compassion because the baby can start to understand that, oh, there's another person there, you know another person separate from me, but like me, you know, but different from me. And that therapy provides another, another version, another attempt to make that leap from self, self-involved sense of you know, why am I not being attended to the way I need to be attended to. To oh I understand, you're like another person, you’re a separate person, that's the seed of kindness, the seed of empathy, the seed of compassion.  

Alzak: Beautiful. Yeah. Yeah. So, you, in one of your chapters, you- there is one of your patients, who is seeking a particular kind of healing, understanding, I think from his parents. And if I recall, you're recognizing that he may not get that from his parents. And then you go further, and you say something like, you’re the healer. And I wrote it down if I can just spot it. Yeah, here it is. That you don't- you're saying, you don't need healing, that you are the healer, and then you evoke the Buddhist bodhisattva of compassion Kwan Yin, meaning, she who hears our cries, and you explain that. So, I was really struck by how you helped him take that leap potentially, you know, from somebody who was identified, perhaps with his emptiness, with his needs, with his woundedness.  

Mark: Well, no it’s- It's more intense than that. [Alzak: Oaky.] So, this case you're referring to was the first case that I wrote down, even before I had set the agenda for the entire book. So, they, the patient in question, was the child of two Holocaust survivors. Each of, each parent had a family in the Old World. Children, husbands, wives in the Old World, who had been eliminated, destroyed, killed, murdered in the concentration camps. And they had met in a displaced- the parents met after liberation. They walked from the camp that they were released from in Germany, they walked to France and then they came to America and then they had this man who became my patient.  

So, he grew up in the shadow, you know, with the horror un-talked about, rarely talked about, horror of both of his parents, having their children. He and his sister born after the war were the, you know, all that all they had. But he had the sense of this incredible grief in, in both of his parents that he could never reach, you know, because they had to keep it. They were doing their best, I think, and he thinks too, just to go on being, you know. So, his cry when he was a boy growing up, he would always ask his parents, was I a good boy today, you know, because he could sense their suffering and as, as children often are, he was taking responsibility for the parents suffering, so he couldn't understand the Holocaust. He didn't know about the, you know, did none of that could have made sense to him. So, he just felt their pain and then was trying to be, as, you know, trying to be a good boy.  

By the time he came to therapy and he's like in his 60s or whatever. He's his plea to me, which you were referencing was, will I ever be healed? When will I ever be healed? Because he was carrying this pain, not just his pain, the generational pain, the pain of his parents, now deceased. Will I ever be healed? So, my improvisational response to him, not thought out in advance, but I had heard this cry from him in other sessions. My response on this day was “you don't need to be healed, you were the healer, you know, there you came, the child they are, your parents lost all those, you know, their sons, their daughters. Then you, what a miracle, you must have been,” you know, and so, so by turning it that way, you know, and then I told him about Kwan Yin, you know, like I said, you're the bodhisattva. You’re already a bodhisattva, you know. And he didn't know what that was, a bodhisattva. So, I said, do you know about Kwan Yin? No, he didn't know about Kwan Yin. So Kwan Yin in Tibet, Kwan Yin changed gender and became Avalokiteshvara with a thousand arms and that each arm was meant to reach down and pluck his suffering being, you know, from the from samsara and pull them, you know, so I was like, you came down, you came to help your parents, you know, Kwan Yin, she who hears your- she who hears our cries. You heard your parents’ cries and you came. So that was helpful to him, you know, and now he's told me, he has, he has Kwan Yin statues in every, in every room of his house and office.  

Alzak: Really?  

Mark: Yeah.  

Alzak: Yeah. Yeah, is there any paragraph or two that you would like to read from your book that you'd like to share with us tonight that pops up in this moment or that you have that you'd like to share? Curious. 

Mark: Well, the Zen thing in the book, you know, the, The Zen of Therapy: Uncovering a Hidden Kindness in Life. That's the book's title. So, I was no scholar of Zen when I started the book, but the- in that Covid time when I was writing the reflections, I started reading a lot of Zen poetry and books about Zen koans and so on. And I found one book, you might know that do you know, John Tarrant? [Alzak: Yes.] He’s a west coast guy. 

Alzak: Yes. I’ve read one of his books years ago. Yeah.  

Mark: Yeah. He has a great book that I came upon called, Bring Me the Rhinoceros and Other Koans, and he like tries to take the mystery out of koans by talking about what they, what is their actual function? And so, I lifted from his book. He goes through one, two, three, four, five, six, seven attributes of koans. Which I think would be nice to read. You know, the most famous koan is what is the sound of one hand clapping? But um, but that wasn't really the original koan, the original koan was just, what is the sound of one hand? And I talk about that one in the book. It had nothing to do with clapping, it was just, what is the sound of one hand? And it came from from Hakuin, who was a great Zen master who became enlightened in his 80s and then, then became a painter and a calligrapher and he did a drawing of this, of this koan. What is the sound of one hand? And the drawing was of a monkey with two hands over his ears, you know, like hunched over his ears, like his mind is going- He's like, you know, an anxious monkey with his hands over his ears and behind him is a, is a bird, a cuckoo flying in the air. And the, the cuckoo in Japanese iconography is like the symbol of springtime. Like young couples go out in the springtime to lie in the grass together, to listen to the sound of the cuckoo and the cuckoo flies with its beak open making its sound, you know, but the monkey can't hear it. And then, and then under it Hakuin writes, lift one hand, you know, lift one hand, even when not listening, you know, so the idea is, what is the sound of one hand? If you take this hand off your ear, you can hear the sound of the cuckoo. So that's the first explication of a koan, but so, so Tarrant in his book, lists these seven attributes of koans. So, I'll read that. Okay? 

Alzak: Great. 

Mark: “Koans show you that you can depend on creative moves. Koans encourage doubt and curiosity. Koans rely on uncertainty as a path to happiness. Koans will undermine your reasons and your explanations. Koans lead you to see life as funny rather than tragic. Koans will change your idea of who you are, and this will require courage. Koans reveal a hidden kindness to life.”  

So that's where I got the subtitle from, you know, straight, straight from John Tarrant. And then a little later in the book, I'll just read you. This is also from him, not from me. “If you are used to living in a small room and suddenly discover a wide meadow, you might feel unsafe. Everyone thinks that they want happiness, but they might not. They might rather keep their stories about who they are and about what is impossible. Happiness is not an add-on to what you already are. It requires you to become a different person from the one who set off seeking it.”  

So, I like the, his description of koans. I see that also as a description of therapy. So, therapy and effective therapy is trying to do what he's saying koans do, you know. They show you that you can rely on creative moves. They encourage doubt and curiosity. Therapy relies on uncertainty as a path to happiness, you know. Therapy will undermine your reasons and your explanations, help you to see life as funny, rather than tragic, change your idea of who you are, and this will require courage. And therapy, hopefully will reveal a hidden kindness in life. 

Alzak: Lovely. Can you say more about how you bring in koans and haiku and various psycho-spiritual teachings in your sessions with patients? How do you weave that in? 

Mark: Oh, I don't, I don't. I only, I only wove that into the book. So, I wove all that into the book to try to describe the intangible, you know, thing about bringing spirituality together with therapy. Like, like what is it? I think it's, it's not so, it's not so concrete as talking about koans or teaching meditation or using haiku. Or that one session that I talked about, with the child of the Holocaust survivors. That, you know, there, I was pulling Kwan Yin and the idea of a bodhisattva in, but that was spontaneous. That was, that's the only time I've ever done that particular thing.  

I tell another story in the book about another session where a woman was in my office and she had several years before lost her soulmate and she was in deep distress, you know, angry, but not really admitting the anger but, but grieving. But I was, I wasn't sure she was grieving in as true a way as maybe she was capable of. And she was repeating something. Something on the order of I just need help. I just need something. I just need something, you know, to make me feel better and I keep in my office, one of, one of my patients came back from an ashram- Neem Karoli Baba’s ashram in India. Came back and brought me a little bag of what they call prasad which is like food that's been blessed that you offer to the gods and then they give back to you and you, so you get some of that good energy. So, I keep it hidden in a ceramic jar on my bookshelf. So, she's like, you know, I just wish I, there was a pill or something magic something. You know, I said, oh I okay you want some- I have that for you and I went and got, got some of the prasad, opened the jar and took it out of the cellophane, you know, and gave it to her and she's like, you know, what is this like some psychedelic thing? No it's like a sugar pill and she took it and it just and it paused the therapy, you know, like she, her cries, her distress was interrupted because I had surprised her with this, you know, with the student didn't make any sense, you know, like this. Like she wasn't a spiritual person. She didn't know what prasad was, you know, but she took it and she put it in her mouth, and she ate it. And the whole complexion of the session, the whole texture of the session changed as a result, and then she went home and that night, she sent me an email saying, I don't know what that was, but that placebo medicine of yours, but it really, you should give that to all of your patients that really changed something for me. And you know, then when I wrote the session up and sent, we had a nice back and forth about that, where that became like a motif for something for her.  

So, you know, various ways like that. But, but that again that was that's not something I thought about in advance. It's like I'm trying to pull on whatever I can to help the people who are under my care. So that means I'll pull that- I tell a story in here of throwing the I Ching with a patient, you know, which is not something that I regularly do. But I must have been stuck in some way with him. And I was looking like John Cage uses the I Ching and I was like, have you ever thrown the I Ching? We could ask that the I Ching what to do here? And he was like, no. I don't- what's the I Ching, you know, so I took it off the shelf and we did it together, and the I Ching was like, he had described a dream that we were having trouble interpreting and the I Ching interpreted the dream perfectly, you know, so I tell that story and the book, so but mostly I'm just like, I'm not like crazy like that. [Alzak laughs] Mostly, I'm just like, you know, listening and trying to offer a helpful response. 

Alzak: Yeah, well, you're obviously also following your intuition and some sort of synchronicity, perhaps. Related to this, I noticed also that there were periods where there was a fair amount of personal disclosure. You were talking a little bit about your family, your vacation, your own process and you're disclosing that also in the book. And, you know, for therapists, that can be a delicate conversation. How much do I say? When do I say it? Is it in service of the patient? What will the impact be, you know, all those delicate moments. I'm curious if you want to share more about how that happens for you. 

Mark: Sure. Well, I'm very aware of all that conversation about personal disclosure and so on, and all the caveats around that. But I remember when I was younger and seeking therapy myself, how much I did not like the therapists who I went to consult with who were hiding behind the blank screen of therapeutic neutrality, you know, in a sort of classic psychoanalytic mode. I didn't want that. You know, I mean, it was the, it was the early 70s. I think, culturally that was out of fashion already, I don't know how much I was just like a victim of the culture, but I think it was more than that. I think I was needing and seeking a real person, someone who could be real with me because I needed to figure out how to be real.  

So, I worked with two different therapists who were linked, one was the teacher and supervisor and therapist of the other. So there's like a lineage thing in therapy, like there is in many spiritual traditions, but both of those therapists were, you know, yes, I'm your therapist. But if we meet outside of the office, I'm not going to be your therapist outside of the office. I'm just a person who you know, and there were no- each of them I saw in their own homes, you know with their newborn child or their, in another case, their lover in the next room, you know, and my office is in the building where a loft building in lower Manhattan in the basement of the building where we also live, and my wife had a studio right next to the office. My children would be in and out of the building, patients would run into them. I made no efforts to hide aspects of my personal life. I was like, you know, and that was difficult for some patients, they didn't want that, but it was mostly just fine. And I think, and I think people really appreciated that I wasn't pretending to be anything other than what I was, you know, and that it didn't- wasn't threatening to know aspects of my personal life. Like, what’s the problem with knowing that your therapist has children? Or has a wife or has a life or, you know, goes to the bathroom or needs to have dinner, or was, is tired or, you know.  

But as you're saying, you know, therapists err on the side also of too much disclosure and that's analogous to the intrusive or interfering parents. You know, who's too busy, making it be all about them instead of about the child. And that's certainly something that I've tried not to be. So, I've been very aware of, I don't think I'm doing any of this without thinking about it.  

Alzak: Oh, yeah, that was really evident to me. In reading it, it was quite skillfully done. And so, I wanted to hear just more about your process around that, so we just have a few minutes left. You end the book with your chapter called “Kindness” and you take this trip to Hawaii to spend some time with Ram Dass after not having seen him for I think a few years.  

Mark: Oh, yeah, 20 years.  

Alzak: Yeah, 20 years, yeah. At the request of Jack Kornfield. 

Mark: At the suggestion of Jack Kornfield. 

Alzak: And so, there's a phrase that you quote from Ram Dass, “We are all walking each other home” and I love that phrase. And as we move towards the end of our conversation, if you want to share anything about what that means to you, what that means to you as a therapist, having the spiritual friendship that you call with patients. Maybe we could take a couple of minutes and end with that. 

Mark: Sure. Well, my friendship with Ram Dass. He was both teacher, teacher and inspiration and friend to me. I wasn't, he had much better friends than me, but we did have a friendship that stretched over, over 40 years and I met him first when I was still an undergraduate in college, and he was just back from India. And a professor of mine, professor of psychology of mine was the person who had both hired and fired Alpert who became Ram Dass and Timothy Leary, but he had stayed friends with him. So, Ram Dass would stay in this professor's house. And I spent a lot of time hanging out at that professor’s house.  

So, I have Ram Dass in the book, both at the beginning, and at the end, a little bit in the middle, because he was really a big influence on my whole approach to being a therapist. And I tell a story of going to visit him, not this last time in Maui, but 20 years before when he was living in Tiburon. Just after he had had a massive stroke that paralyzed him on one side and made it very difficult for him to find the words for what he was thinking. He had an Aphasia, which is very common when people have this kind of stroke. So, his thinking wasn't impaired, but he couldn't put the words on what he wanted to say, and I went to visit him. I was in my mid 40s by then. So, I'd been working as a therapist for more than a decade for sure. And I hadn't seen him in 10 years probably at that point and he greeted me. And he always kind of teased me and I know for him, I was always about 21 years old, you know, because which is when he first met me.  

So, he's like, Mark, are you a Buddhist therapist now? You know, with a little bit of little, little edge and I was like, yeah. Yeah, I guess I am, you know, and then, and then he said this thing that took him a long time to say, but he found the words and he said, Do you see them? Meaning my patients. Do you see them as already free? But he spread it out over time. Do… you… see… them… as already free? Took me a long time meaning, you know a minute or so to understand what he was saying. And I couldn't have conceptualized it like that, but he could but it struck me as absolutely true. And that vision, you know, of a kind of innate Buddha nature or innocence, but also wholeness that already there behind the elaborated personality or the defensive structure that we all build up, you know, that sense that the person who's coming in for therapy is, you know, embroiled in their problems, but that, but that they're also already free, you know, so that there's another, there's something else in them that I can reach for in my interactions. That really has guided me all the way through my years as a therapist.  

And so, then another 20 years went by, you know, before I then I went to Maui as you're saying at Jack Kornfield’s suggestion because he said, you have to go see Ram Dass, you know, he's become the person that he always wanted to be, you know, all those 20 years or so of suffering under the stroke. He was, he never complained about it. He was continuing to put out a loving energy to all the people who were, you know, helping him and around him and, and he had no need anymore to pretend to be Ram Dass, you know. So, I tried to write about that at the end of the book as, as a description, maybe of what might be possible for, for all of us.  

But that thing of, that thing of being already free, a friend of mine, I have it here. A friend of mine who heard me talking about this, on another podcast, not that long ago, just sent me this email. It's pretty short. Let me read it to you. Okay? [Alzak: Yeah.] So, she's an old friend. So, she said, you know, I'm reading your book and you know, I like it blah blah. “I've heard you tell the Ram Dass story in which he asked you if you see your therapy clients as already free a couple of times,” she writes. “I could never really understand what he meant and what you understood about that question. Somehow hearing it again and being out in California as an active grandparent, I have found my own understanding of that question. In a way that I was never able to see my children, I see my granddaughters as already complete with the capacities they will need, even though I do not have a clue about what the specifics of their childhood or lives as adults will be. I know they have an enormous amount to learn and experience and their own windy road to travel, but I see them as free or as complete souls. Somehow that understanding lets me be present with them in a deep way. Not sure if this at all overlaps your understanding, but I thought I would share it anyway. Love to you and your family.” 

Alzak: That really encapsulates it right there.  

Mark: Yeah something, isn’t it? 

Alzak: [sighs] Thank you. Just very moved and filled by this conversation. Well, so we're about to the end of our time. This has just been really rich and dynamic, and it went to lots of amazing places. So, I'm very grateful that you've come to CIIS, that you've offered so much. There's a lot to unpack here. The book is, has about 50 or so I think chapters of different folks.  

Mark: Short, short little chapters. Don’t worry. 

Alzak: Yes, 2 to 4 pages about. Yeah, so, they're pithy and, and loaded with experience and information. So, so I’m grateful to have met you and to have had a conversation with you and learn from you. And so maybe you want to say some closing words before we fully end, Mark. 

Mark: Well, I've just always wanted to come to CIIS. So, so I'm almost there and thank you for having me at least virtually. And, you know, I really respect the work that's going on there, so glad to be part of it a little bit. 

Alzak: Great. Well, hopefully you'll come back.  

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Thank you for listening to the CIIS Public Programs Podcast. Our talks and conversations are presented live in San Francisco, California. We recognize that our university’s building in San Francisco occupies traditional, unceded Ramaytush Ohlone lands. If you are interested in learning more about native lands, languages, and territories, the website native-land.ca is a helpful resource for you to learn about and acknowledge the Indigenous land where you live. 
 
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